Definitive Obturator Prosthesis Research Articles

Definitive Obturator Prosthesis Post Mandibular Dredging for Treatment Ameloblastoma Patient: A Case Report

Background: Ameloblastoma is an odontogenic tumor that can cause bone destruction in the mandible. Mandibular dredging is a conservative treatment that involves enucleation and curettage of tumor tissue to remove tumor tissue from the bone-tooth loss after mandibular dredging treatment results in reduced occlusion function and aesthetics. A definitive obturator prosthesis is helpful to restore occlusions and aesthetics.

Prosthetic Rehabilitation of Post Covid Mucormycosis of Maxilla with Definitive Obturator Prosthesis- A 24 Month Follow Up Case Report

The second wave of COVID-19 in April 2021 witnessed a new mutated variant of SARS-CoV2 known as B.1.617 resulting in Mucormycosis. Inhalation, ingestion, or contamination of ulcerated mucosa by fungal spores results in infection and cause Mucormycosis. Objective: To highlight how a complex case of oral mucormycosis can be misdiagnosed due to its similar clinical presentations with other periodontal diseases and benefits of prosthetic rehabilitation of surgical defects with definitive obturator which improves the quality of life by restoring oral function and aesthetics. Case report: A 35-year-old female reported with chief complaint of pain, pus and mobility in upper front teeth region of 2 months and swelling of mid-face. Darkening of skin, swelling with tenderness over bilateral malar- infraorbital regions with epiphora and blurred vision in right eye and discharge from right nostril. She had multiple abscess in attached gingiva in incisor and premolar region of maxilla having probing depths ≤ 4mm with mobility. Conclusion: A precise diagnosis is prerequisite to specific treatment of any disease. Treatment often requires an extensive surgical resection causing facial deformation, masticatory, swallowing and speech problems. It is important to rehabilitate these patients by correcting the defects with the help of obturators and improve their lifestyle.

Digital acoustic analysis of the first three formant frequencies in patients with a prosthesis after maxillectomy

Statement of problemProsthetic rehabilitation with an obturator can help to restore or improve the intelligibility of speech in patients after maxillectomy. The frequency of formants 1 and 2 as well as their ranges were initially reported in patients with maxillary defects in 2002, and the evaluation method that was used is now applied in clinical evaluation. However, the details of formant 3 are not known and warrant investigation because, according to speech science, formant 3 is related to the pharyngeal volume. Clarifying the formant frequency values of formant 3 in patients after maxillectomy would enable prosthodontists to refer to these data when planning treatment and when assessing the outcome of an obturator. PurposeThe purpose of this clinical study was to determine the acoustic characteristics of formant 3, together with those of formants 1 and 2, by using a digital acoustic analysis during maxillofacial prosthetic treatment. The utility of determining formant 3 in the evaluation of speech in patients after maxillectomy was also evaluated. Material and methodsTwenty-six male participants after a maxillectomy (mean age, 63 years; range, 20 to 93 years) were included, and the 5 Japanese vowels /a/, /e/, /i/, /o/, and /u/ produced with and without a definitive obturator prosthesis were recorded. The frequencies of the 3 formants were determined, and their ranges were calculated by using a speech analysis system (Computerized Speech Lab CSL 4400). The Wilcoxon signed rank test was used to compare the formants between the 2 use conditions (α=0.05). ResultsSignificant differences were found in the frequencies and ranges of all 3 formants between the use conditions. The ranges of all 3 formants produced with the prosthesis were significantly greater than those produced without it. ConclusionsBased on the findings, both the first 2 formants and the third formant were changed by wearing an obturator prosthesis. Because formant 3 is related to the volume of the pharynx, evaluation of this formant and its range can reflect the effectiveness of the prosthesis to seal the oronasal communication and help reduce hypernasality, suggesting the utility of formant 3 analysis in prosthodontic rehabilitation.

IN SITU ORAL MELANOMA: DIAGNOSIS, TREATMENT, AND FOLLOW-UP

Oral melanoma is an aggressive cancer in which the cells display melanocytic differentiation. In situ oral melanoma is considered an extremely rare tumor and the prognosis is poor compared to its cutaneous counterpart. A 67-year-old woman was referred for evaluation of a lesion on the maxillary alveolar mucosa. Intraoral examination revealed a nondetachable black patch on the maxillary alveolar mucosa extending to the hard palate with irregular borders and well-defined limits measuring 3 × 1.5 cm. A biopsy was performed, and microscopic analysis showed moderate atypical junctional melanocytic. Immunohistochemical analysis was positive for S-100, melan-A, and melanosome. The definitive diagnosis was in situ oral melanoma and the patient was treated surgically with partial maxillectomy. A definitive obturator prosthesis was made to provide effective rehabilitation. A 15-month follow-up showed no evidence of recurrence or metastasis. Oral melanoma is an aggressive cancer in which the cells display melanocytic differentiation. In situ oral melanoma is considered an extremely rare tumor and the prognosis is poor compared to its cutaneous counterpart. A 67-year-old woman was referred for evaluation of a lesion on the maxillary alveolar mucosa. Intraoral examination revealed a nondetachable black patch on the maxillary alveolar mucosa extending to the hard palate with irregular borders and well-defined limits measuring 3 × 1.5 cm. A biopsy was performed, and microscopic analysis showed moderate atypical junctional melanocytic. Immunohistochemical analysis was positive for S-100, melan-A, and melanosome. The definitive diagnosis was in situ oral melanoma and the patient was treated surgically with partial maxillectomy. A definitive obturator prosthesis was made to provide effective rehabilitation. A 15-month follow-up showed no evidence of recurrence or metastasis.

Prosthetic Rehabilitation of Cancellous Osteoma – A Case Report

Osteomas are benign osteogenic lesions of the bone. When this involves the maxilla and requires resection, maxillectomy defect results and this in turn leads to compromised function in terms of mastication, speech and also psychological well-being. Definitive obturator prosthesis fabricated with maximum extension and incorporation of proper design rehabilitates the patient by improving masticatory efficiency, increasing speech clarity, improves the esthetics, thereby enhancing the overall quality of life. This case report presents one such case of a rare intraoral peripheral cancellous osteoma affecting the maxilla and its prosthetic rehabilitation following surgical resection

Interdisciplinary prosthetic rehabilitation following bilateral maxillectomy with total upper lip and unilateral zygoma resection: A clinical report

This clinical report describes the design and fabrication of an implant-retained and soft-tissue-supported obturator prosthesis and a magnetic retained midfacial prosthesis for a patient with a midfacial defect following bilateral total maxillectomy, removal of the left zygoma, and excision of the entire upper lip. The patient underwent multiple head and neck surgeries for 4 separate primary oral cancers, 1 recurrence, and 1 pulmonary metastasis. The definitive obturator prosthesis was retained by 1 zygomatic implant with soft-tissue support and retention. The midfacial prosthesis was attached to the obturator prosthesis with magnets, improving appearance and the recovery of significant aspects of the patient’s speech and swallowing. Some improvement in mastication was observed.

A simplified technique for fabrication of obturator using light curing wax pattern: A case report

Surgical excision of the maxilla results in communication between the oral cavity, nasal cavity and maxillary sinus. Rehabilitation of such defects involves fabrication of obturator prosthesis by the maxillofacial prosthodontist. Various techniques and materials have been used in the past for rehabilitation of such defects.To Fabricate a Obturator Prosthesis using Light Cure Wax Pattern.A 65-year-old man reported with the chief complaint of inability to chew food due to an ill-fitting prosthesis. His history revealed that patient had undergone maxillectomy of left side due to Carcinoma maxilla 03 years back, followed by the fabrication of a definitive obturator prosthesis. Intraoral examination revealed a well healed Aramany’s Class II post maxillectomy defect on the left side measuring 5 cm X 3.5 cm anteroposteriorly and mediolaterally, with everted margins and irregular borders. This clinical report describes rehabilitation of maxillectomy defect with definitive obturator prosthesis. A light cure wax pattern was used (LiWa®; Willmann & Pein Gmbh) for the fabrication of metal framework.Fabrication of a cast metal framework involves a complex laboratory procedure to achieve the clinical success of the prosthesis. LiWa light curing waxes can be successfully used as an alternative to the conventional wax pattern for the fabrication of cast partial dentures framework for definitive obturators.The light cure wax pattern helped in reducing the number of laboratory steps and allowed wax pattern trial in the patient's mouth, saving precious time and ensuring a precise fit of the prosthesis.

Prosthetic Rehabilitation of An Acquired Maxillary Defect with Definitive Obturator Prosthesis- A Clinical Technique

Prosthetic Rehabilitation of An Acquired Maxillary Defect with Definitive Obturator Prosthesis- A Clinical Technique

The use of optical scanner for the fabrication of maxillary obturator prostheses.

Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner. Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction. Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing. Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.

Obturator fabrication incorporating computer-aided design and 3-dimensional printing technology: A clinical report

This article reports an approach to fabricating a maxillary obturator using the computer-aided design and computer-aided manufacturing (CAD-CAM) process. The maxillary definitive cast and the trial tooth arrangement were separately scanned and superimposed. The virtual cast created from the scan data was surveyed, and the framework was designed using specific software. The definitive cobalt-chromium framework was fabricated by using 3-dimensional (3D) selective laser sintering (SLS) technology. After framework trial placement, the definitive obturator prosthesis was processed using conventional heat-polymerizing resin with the lost-wax processing technique. Using CAD technology and 3D metal printing resulted in improved fit, function, and esthetics for the definitive obturator prosthesis.

The use of direct metal laser sintering technology in the management of acquired maxillofacial defects due to malignant neoplasm

Rehabilitation of maxillary defects presents a significant challenge in terms of restoration of near normal functions following the healing of large surgical wound. The obturator prostheses as a part of prosthetic management are used for the separation of oral and nasal cavities to allow adequate deglutition and articulation and support for the soft tissue to restore the midfacial contour in palatal defect cases. This clinical report describes a prosthetic approach to the rehabilitation of an acquired palatomaxillary defect with definitive obturator prosthesis as well as guide flange prosthesis for the management of mandibular deviation.

Impact of Maxillofacial Prostheses on Oral Health Related Quality Of Life (OHRQoL)

Maxillofacial defects cause impact on oral health related quality of life (OHRQol) including limitations in functional activities, communication, social interaction, and intimacy. The obturator prosthesis is commonly used as an effective means for rehabilitating maxillectomy patients. The purpose of this study was to investigate impact of definitive obturator prosthesis on oral health related quality of life. In the period between 2015 -2017, a total of twenty five (25) patients with acquired maxillary defects based on Okay classification have been selected and rehabilitated with definitive obturator prostheses .The OHRQol was measured using the Oral Health Impact Profile (OHIP-Edent-19) and Obturator functioning scale (OFS) with standardized questionnaire after 2 weeks & 3months of prosthesis function.To find the significant difference between the bivariate samples in Paired groups the Wilcoxon signed rank test was used. With respect to oral health impact profile –Edent 19 scale, the mean functional limitation score were 6.72 and 5.20 indicates that there is significant improvement in chewing performance after 2 weeks and 3 months of prosthesis function. Significant improvement in oral health impact profile was noticed in physical (M = 5.84, 4.88), Psychological (M=4.84, 3.96) and social disabilities (M=5.28, 4.16). Similarly, when observed with Obturator functioning scale, significant improvement were noted in chewing performance phonetics, appearance and miscellaneous aspects. Analysing the OHIP –Edent-19 scale and obturator functioning scale (OFS-15), statistically significant differences (Wilcoxon rank test p value = 0.0005) were observed. Within the limits of this study, it can be concluded that highly positive correlation exists between definitive obturator prostheses and oral health related quality of life (OHRQol).

Prosthetic rehabilitation of a patient with near total maxillectomy using a hollow bulb obturator: a case report

Aim: To prosthetically rehabilitate maxillary defect in a patient with near total maxillectomy using hollow bulb obturator.Case description: Authors report a case of 64-year-old male patient with near total maxillectomy with respect to the left side who was referred for the prosthetic rehabilitation.Conclusions: The hollow bulb definitive obturator prosthesis rehabilitated the patient in terms of masticatory function, phonetics and esthetics. The hollow bulb design ensured patient comfort due to its decreased weight.

A Titanium Cast Hollow Definitive Obturator Prosthesis for a Maxillectomy Patient

ABSTRACT Oral cancer necessitates the surgical removal of all or part of the maxilla. The extent of surgical resection is dependent on the size, location, and potential behavior of the tumor. The maxillectomy procedure leaves the patient with a defect that compromises of the integrity and function of the oral cavity, leading to hypernasal speech, fluid regurgitation into the nasal cavity, and impaired masticatory function. Rehabilitation of subtotal and total bilateral maxillectomy surgical defects is a complex challenge to the prosthodontist. Prosthetic rehabilitation of the surgical defect with the help of obturator is very important, because the resulting functional deficiencies have a detrimental effect on the quality of life and self-esteem of the patient. How to cite this article Fernandez T, Rodrigues SV, Vijayanand KR. A Titanium Cast Hollow Definitive Obturator Prosthesis for a Maxillectomy Patient. Int J Prosthodont Restor Dent 2016;6(3):69-72.

Rehabilitation of maxillectomy defect with obturator prosthesis

The acquired defects of the palate are created commonly surgical intervention of benign or malignant neoplasms. The size and location of the defect influence the level of difficulty in prosthetic rehabilitation. Surgical intervention creates anatomic defect which forms communication among the oral cavity, nasal cavity and maxillary sinus. The goal of prosthodontist is to rehabilitate missing oral and extra oral structures with restoration of normal anatomic and physiologic function. Prosthetic rehabilitation with obturator restores the oral structures and also acts as barriers between communications among the cavities. Acquired maxillary defects of the palate are seen in patients suffering from benign and malignant neoplasms, trauma, pathologic changes, radiation therapy and surgical intervention. Ablative surgical therapy is frequently adopted for the control of malignancies and other abnormal growths. This results in anatomic defect that allows the oral cavity maxillary sinus and nasal cavity to become one compartment, abrupt alteration of physiologic functions such as speech, mastication, deglutition and salivary control. Prosthodontics rehabilitation for an acquired maxillary defect begins immediately at the time of surgical resection. Prosthetic rehabilitation begins with a surgical obturator, which is inserted at the time of surgery to help retain the packing, prevent oral contamination of the surgical wound and skin graft, and to allow the patient to speak and swallow during the initial post operative period. The surgical obturator is commonly converted into an interim obturator with the addition of resilient lining material to adapt to the defect. Definitive obturator is initiated approximately 3 to 4 months after surgery when healing is complete. The impression for definitive obturator prosthesis should include the skin graft mucosal junction, lateral aspect of the orbital floor, and the dynamic physiology of the velopharyngeal mechanism during speech and swallowing. The obturator bulb must also be contoured to prevent obstruction of nasal breathing and to maintain nasal resonance during speech. The degree of extension into the defect varies depending upon the configuration of the defect, character of its lining tissue, and functional requirement for retention, stability and support of the prosthesis. This article describes a case report of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma and rehabilitated with definitive obturator.

Flexible resins in the rehabilitation of maxillectomy patient

Surgical resection is an established and common method for treatment of maxillofacial tumors. Such intervening surgery in this region may involve the destruction of antral, nasal, or orbital contents and jaws. Normally, the end result is a defect which may affect speech, swallowing, mastication and facial appearance. Prosthodontic restoration of functions and facial form is an excellent method in the replacement of missing parts and restoration of contour. Pertinent research in materials, designs and methods have resulted in whole array of possible prosthess that can be provided to meet specific patient needs. This case report describes the fabrication of definitive obturator prosthesis made of flexible acrylic resin on a chrome cobalt base.

A Maxillary Obturator Prosthesis for an Active Duty Air Force Flyer: A Case Report

To fabricate a maxillary obturator prosthesis for an active duty pilot allowing him to return to active flying status. A 24-year-old male active duty U.S. Air Force pilot presented with a history of right posterior maxillectomy due to a keratocyst odontogenic tumor. The patient had been wearing an interim obturator prosthesis for 4 months and was removed from active duty flight status. A comprehensive oral evaluation was completed and a definitive obturator prosthesis was fabricated using a cast metal framework. Extraoral 3D stereophotogrammetry and a facial moulage were accomplished. The patient underwent evaluation for return to active flying status. The patient returned to active duty flight status after passing all of the required tests. Obturator prostheses may be a suitable treatment option allowing a patient to conduct all of the required functions of an active flyer.

Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: Case series of five patients

Purpose The purpose of this case report is to demonstrate the benefits and applicability of appropriate maxillofacial prosthetic rehabilitation following surgical resection of ameloblastoma of the maxilla in Kenya. Materials and methods Five patients presenting with ameloblastoma of the maxilla over 3 years were studied with respect to histologic type, site of tumor, resultant surgical defect, and form of definitive obturator prosthesis. Impressions were taken using irreversible hydrocolloid and poured with dental stone. Immediate surgical obturators were fabricated from casts using clear autopolymerizing acrylic resin. One patient had bilateral partial maxillectomy, whereas the rest had unilateral partial maxillectomy. Immediate surgical obturators were fitted intraoperatively and held in place using Adams clasps on the remaining natural dentition for all patients, except the one who had undergone bilateral partial maxillectomy, whose surgical obturator was held loosely using circumzygomatic wires. After 6 to 8 weeks, surgical obturators and packing were withdrawn, and new impressions were taken to fabricate definitive obturators. Patients were reviewed every 2 weeks for 3 months, then once every 3 months per year for 3 years, and thereafter once per year. Results The immediate surgical obturators facilitated retention of the surgical packing, promoting healing with minimal postsurgical infection and scar contracture formation. This ensured the restoration of acceptable esthetics and maintenance of oral function at a reasonable level during the initial postoperative period. Definitive obturators restored esthetics, oral function, and ability to handle secretions to a satisfactory level. Conclusion Satisfactory functional and esthetic results are achievable in patients with extensive acquired maxillary defects by means of obturator prostheses fabricated using readily available materials.— Reprinted with permission of Quintessence Publishing.

A maxillary lip prosthesis retained by an obturator with attachments: A clinical report

This article describes the prosthetic rehabilitation of small maxillary lip and maxilla defects with a lip prosthesis attached to an obturator. The definitive obturator prosthesis was designed with 3 plastic ball attachments on the labial surface that provided adequate retention for the lip prosthesis. The thin margin of the lip prosthesis ensured that it adapted well to functional movements. (J Prosthet Dent 2002;88:135-8.)

Prosthetic rehabilitation of the edentulous patient requiring a partial maxillectomy

A variety of problems faces the prosthodontist attempting reconstruction of maxillary defects. This article reviews developments in materials and techniques of obturator prosthesis design for patients experiencing maxillectomy. The size of the maxillectomy defect is one of the main factors governing the prognosis for treatment. Many patients require special prosthodontic techniques. However, routine attention to extension of the prosthesis and balanced occlusion is essential. Obtaining satisfactory retention and stability in the definitive obturator prosthesis can be elusive. Resilient denture base materials are extremely useful in retaining the prosthesis, which obturates small defects. However, the flexibility of these materials makes them unsuitable in large maxillectomy cavities because of the deformation that occurs during mastication. Alternative forms of retention, eg., osseointegrated implants and sectional prostheses retained by magnets, are discussed.